Catatonic Depression: Symptoms, Causes, & Treatments

Written by Michael Kerr
| Published on March 29, 2012Medically Reviewed by George Krucik, MD

Catatonic depression is a type of depression where the person can remain speechless and motionless for an extended period of time.

In 1843, French neurologist and psychiatrist Jules
Baillarger described a syndrome in which patients appeared in "a state of
stupor, with fixed gaze, a facial expression of frozen astonishment, muteness,
and indifference." The condition later became known as catatonia.

Originally catatonia was believed to be a type of
schizophrenia, but more recent studies found that more than one quarter of
patients with mania and 20 percent of individuals with depression experience
symptoms of catatonia. Today, catatonia is considered a neuropsychiatric
syndrome associated with several other conditions including post-traumatic
stress disorder, bipolar disorder, and depression. Catatonic depression is no
longer recognized as a separate disorder by the American Psychiatric
Association.

Fortunately, catatonic depression is also easily treatable.

Symptoms of Catatonic
Depression

In depression, catatonia is most often associated with
bipolar I disorder. In bipolar I, a patient experiences periods of mania broken
by severe depressive episodes. It may also be found in other mood disorders
including bipolar II and major depressive disorder (MDD).

In addition to other symptoms of depression, catatonic
patients may experience:

extreme negativism

hypokinesis: immobility or being
unable to move

selective mutism: the patient is
unable to speak due to extreme anxiety

Severely depressed individuals with catatonia may have
difficulty completing normal tasks. For instance, the simple act of sitting up
in bed up may take hours.

Catatonia in severely depressed people often manifests in
similar physical symptoms as those with catatonic schizophrenia.

An individual with catatonic depression may need to be
monitored by a clinician or caregiver to make sure she doesn't harm herself or
others.

Causes
of Catatonia

Experts believe mood disorders are caused at least in part
by irregular production of neurotransmitters, chemicals in the brain that allow
cells to communicate with each other. The two neurotransmitters most often
associated with depression are serotonin and norepinephrine.

Antidepressants such as selective serotonin re-uptake
inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs)
work by acting on those specific receptors.

Catatonia, on the other hand, is believed to be caused by
irregularities in the dopamine, gamma-aminobutyric acid (GABA), and glutamate
neurotransmitter systems. Because catatonia is always accompanied by an
underlying neurological, psychiatric, or physical illness, its diagnosis must
focus on the root cause in order to successfully treat the catatonic symptoms.

Treatments

Benzodiazepines and electroconvulsive therapy (ECT) are the
main treatments for catatonic symptoms in depression. Increasingly,
N-methyl-D-aspartic acid (NMDA) antagonists, certain atypical antipsychotics,
and repetitive transcranial magnetic stimulation (rTMS) are being used to treat
catatonia as well.

Benzodiazepine

Benzodiazepines is a psychoactive drug that enhances the
effect of the neurotransmitter gamma-aminobutyric acid (GABA), and is effective
in quickly relieving catatonic symptoms in most patients, including anxiety,
muscles spasms, agitation, and insomnia.

The benzodiazepine lorazepam has been the most common
treatment, resolving catatonic symptoms in 70 percent of patients.

Electroconvulsive Therapy

Electroconvulsive therapy is by far the most effective
treatment for catatonia, resolving symptoms in 85 percent of cases. Although
ECT is now considered a safe and effective treatment for a range of mood
disorders and mental illnesses, there is still a stigma surrounding
?"electroshock therapy" and it currently lags behind benzodiazepine
as the primary treatment for catatonic symptoms. However, a combination of
lorazepam and ECT may be the best treatment for catatonia.

NMDA
There is growing
evidence showing N-Methyl-D-aspartate (NMDA)—an amino acid derivative which
mimics the behavior of the glutamate neurotransmitter—can be used to
effectively to treat catatonia as well, although more studies are needed to
adequately address its effectiveness and side effects.

rTMSOther treatments that have shown promise are repetitive Transcranial
Magnetic Stimulation (rTMS) and certain atypical antipsychotics—particularly
those that block D2 receptors—may be effective as well but, as with NMDA, more
research is necessary.

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